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16 Cards in this Set
- Front
- Back
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PSA screening recommendations (USPSTF and AUA)
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USPSTF – D rating (don’t recommend for anyone)
AUA – (q2 years okay) <40 no one 40-54 doesn’t recommend (unless family hx or AA) Recommend for 55-69 >70 or <10yrs life expectancy, doesn’t recommend NCCN – 45-49 baseline PSA (<1 repeat at 50, > 1 q1-2 yrs) 50-70 PSA<3 cont screening q1-2yrs, 3-10 Bx or PCA3 >70 continue in very healthy men |
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Risk Factors for Prostate Cancer
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Family Hx – 1st degree 2x, 2 1st degree 9x
AfroAmerican>Caucasians>Asians (Highest in Scandinavia lowest in Asia) Fat, vasectomy, Sex does not make a difference |
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What is the PPV of DRE for CaP Dx?
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15-25% of men with abnormal DRE have prostate cancer
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Prostate cancer risk reduction
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PRIMARY
SELECT – (Vit E and Selenium) vit E increases risk by 17%, no diff with Selenium Finasteride – PCPT decreased risk 24.8% but increased risk of HG. No difference in survival Dutasteride – REDUCE decreased risk of CaP 22-24% (not HG) Vit D and omega 3 don’t reduce risk TERTIARY REDEEM – Dutasteride prevented localized prostate cancer progression (HR 0.62) |
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ASAP/HGPIN on biopsy, what next?
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ASAP - Repeat biopsy within 3-6 months with extended template.
HGPIN – follow with PSA and DRE |
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PSA Surrogates
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fPSA (>50yrs, PSA 4-10, nl DRE) - <10%-25% increased risk
PCA3 (following neg prostate biopsy) >35 PSAD 0.15 (Low/Int vs. High risk) PSAV >2 (Low/Int vs. HR) PSADT 3mo (high risk), 15 mo (low risk) |
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Where is prostate cancer in the prostate?
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PZ 70%
TZ 20% (BPH) CZ 10% |
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Prostate cancer Histology
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Adenocarcinoma: Acni (most common), Ductal (aggressive, in ducts to urethra), Mucinous (secrete mucus, not in ducts)
Transitional Cell – very aggressive. Operate Neuroendocrine – poor prog. Operate |
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Gleason Scoring System
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Most common + 2nd most common
1 – Normal prostate tissue 2 – Well formed glands, larger with increased stroma. Uniform gland size 3 – Recognizable glands with darker cells, some invasion into BM, variation in gland size 4 – Few recognizable ducts, cells invading. Gland fusion (no stroma) 5 – No recognizable glands, sheets |
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Active Surveillance Trials
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SPCG-4 (Holmberg trial) – pre-PSA RP vs. WW, improved OS and CSS (0.56) in men <65, decreased need for ADT and mets in all men. NNT 8 (4 if < 65). Critique – on 12% with cT1 disease
PIVOT – post PSA, reduced all-cause mortality in PSA>10 and possibly intermediate and high risk cancers |
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Adjuvant Treatments to RP
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Neoadj – decreases +SM but doesn’t affect outcomes, confuses path
Adj ADT – No benefit to ADT for gross +LN, Messing Trial showed immediate ADT for micro +LN improves survival Adj XRT – SWOG 8794 Immidiate adj XRT for +SM or pT3 improved survival, Bolla EORTC 22911 same study improves PFS (PSA cutoff 0.3 might not hold for ultraPSA) Salvage XRT – ongoing. Likely better with low threshold (ultrasensitive). |
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Post prostatectomy recurrence cutoff, location, treatment
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PSA>0.2, DRE, BS, CT scan
Early – distant, Delayed – local |
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ASTRO-Phoenix Criteria
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Nadir + 2ng/dL with a second confirmation to define failure
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Who benefits from ADT for XRT
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Intermediate and high risk benefit from long term (Bolla showed 3 years)
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What isotopes are used for Brachy?
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iodine (I) 125, Paladium (Pd) 103
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PSA Bounce
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Following XRT, 1/3 of men, not on ADT, occurs 1-3 yrs post XTR, lasts 6-18 months, Usually around 1 ng/dL
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